Accuracy of Inflammatory Biomarkers for Ruling out Invasive Bacterial Infections in Young Febrile Infants
Carlsson, Ebba Nordström ; Ansorge, Julie and Orfanos, Ioannis LU
(2025)
In Acta Pædiatrica
p.1-7
- Abstract
AIM: To investigate the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP) and absolute neutrophil count (ANC) to rule out invasive bacterial infections (IBI) in well-appearing febrile infants aged ≤ 60 days.
METHODS: Multicentre study of infants ≤ 60 days with fever without source. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ANC, CRP and PCT.
RESULTS: We included 2053 well-appearing infants. The sensitivity of PCT > 0.5 ng/mL was 83% (95% CI, 45%-99%), the specificity was 90% (95% CI, 88%-92%), the PPV was 7.4% (95% CI 2.7-15.1) and the NPV was 99.8% (95% CI 99.2-100). The sensitivity of CRP > 20 mg/L was 63% (95% CI, 43%-50%) and... (More)
AIM: To investigate the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP) and absolute neutrophil count (ANC) to rule out invasive bacterial infections (IBI) in well-appearing febrile infants aged ≤ 60 days.
METHODS: Multicentre study of infants ≤ 60 days with fever without source. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ANC, CRP and PCT.
RESULTS: We included 2053 well-appearing infants. The sensitivity of PCT > 0.5 ng/mL was 83% (95% CI, 45%-99%), the specificity was 90% (95% CI, 88%-92%), the PPV was 7.4% (95% CI 2.7-15.1) and the NPV was 99.8% (95% CI 99.2-100). The sensitivity of CRP > 20 mg/L was 63% (95% CI, 43%-50%) and of ANC > 4090/μL was 72% (95% CI, 50%-89%). There was 1 IBI with PCT ≤ 0.5 ng/mL and 9 IBIs with CRP ≤ 20 mg/L.
CONCLUSIONS: Procalcitonin showed the highest accuracy for ruling out IBI in well-appearing febrile infants aged ≤ 60 days. With a PCT cutoff of 0.5 ng/mL, CRP and ANC had no extra value in ruling out IBIs, while ANC had an added value with a CRP cutoff of 20 mg/L. The PPV of PCT > 0.5 ng/mL was low, which can lead to unnecessary investigations, antibiotic treatments and hospitalisations.
(Less)
- author
- Carlsson, Ebba Nordström
; Ansorge, Julie
and Orfanos, Ioannis
LU
- organization
- publishing date
- 2025-06-26
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Acta Pædiatrica
- pages
- 1 - 7
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:40568980
- scopus:105009248716
- ISSN
- 1651-2227
- DOI
- 10.1111/apa.70201
- language
- English
- LU publication?
- yes
- additional info
- © 2025 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.
- id
- 3360817a-d197-4d7f-a903-0cc4d1ed8855
- date added to LUP
- 2025-07-01 23:03:04
- date last changed
- 2025-07-23 04:53:07
@article{3360817a-d197-4d7f-a903-0cc4d1ed8855,
abstract = {{<p>AIM: To investigate the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP) and absolute neutrophil count (ANC) to rule out invasive bacterial infections (IBI) in well-appearing febrile infants aged ≤ 60 days.</p><p>METHODS: Multicentre study of infants ≤ 60 days with fever without source. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ANC, CRP and PCT.</p><p>RESULTS: We included 2053 well-appearing infants. The sensitivity of PCT > 0.5 ng/mL was 83% (95% CI, 45%-99%), the specificity was 90% (95% CI, 88%-92%), the PPV was 7.4% (95% CI 2.7-15.1) and the NPV was 99.8% (95% CI 99.2-100). The sensitivity of CRP > 20 mg/L was 63% (95% CI, 43%-50%) and of ANC > 4090/μL was 72% (95% CI, 50%-89%). There was 1 IBI with PCT ≤ 0.5 ng/mL and 9 IBIs with CRP ≤ 20 mg/L.</p><p>CONCLUSIONS: Procalcitonin showed the highest accuracy for ruling out IBI in well-appearing febrile infants aged ≤ 60 days. With a PCT cutoff of 0.5 ng/mL, CRP and ANC had no extra value in ruling out IBIs, while ANC had an added value with a CRP cutoff of 20 mg/L. The PPV of PCT > 0.5 ng/mL was low, which can lead to unnecessary investigations, antibiotic treatments and hospitalisations.</p>}},
author = {{Carlsson, Ebba Nordström and Ansorge, Julie and Orfanos, Ioannis}},
issn = {{1651-2227}},
language = {{eng}},
month = {{06}},
pages = {{1--7}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Pædiatrica}},
title = {{Accuracy of Inflammatory Biomarkers for Ruling out Invasive Bacterial Infections in Young Febrile Infants}},
url = {{http://dx.doi.org/10.1111/apa.70201}},
doi = {{10.1111/apa.70201}},
year = {{2025}},
}